Title Page
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Conducted on
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Conducted by - Name
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Permit Number
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Location
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Work Description
Work Details
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Is their a permit board with the correct information?
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Excavation Type?
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Weather conditions?
SLG (Signage, Lighting and Guarding)
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Is there an NRASWA Ticket Qualified Operative on site and Supervisor contactable?
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Have you marked all other utilities along the route of excavation?
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Do all excavations have linked barriers to prevent access to the site from ANY direction? (including open plan, driveways and pedestrian accesses)?
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Do all works in the road have Keep Right/Left arrows, Traffic Cones and Tapers?
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Is SLG (Signage, lighting, Guarding) on site and placed correctly?
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Is the signage in good condition, clean, weighted & lit (if required)?
- Yes
- No
- N/A
Traffic Management
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Is the Traffic Management correct for the works?
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Are the road/footway plates secure and fit for purpose?
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Have you checked the minimum widths for traffic in the<br>carriageway?
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Is the road closure/diversion route appropriate & approved?
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Are Pedestrian Ramps appropriately situated and are they undamaged, Ridgely fixed or rubber edged? (if required)?
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Is your Pedestrian Management correct and safe? (1m remaining/Ped Arrows for walkways/Footway Closed Ahead of Footway Closed or visa versa)?
PPE
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Are they wearing the correct PPE?
General Site Safety
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Is the site tidy, and being managed considerately?
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Are the excavations safe?
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Is relevant H&S documentation on site?
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General Site Safety - Pass or Fail?
Observation and Signature
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Observation
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Engineer signature